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Texas rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Facilitymedian $2,188 · 10th–90th $158–$6,1660%5%10%10th90th$2,188Professionalmedian $138 · 10th–90th $79–$2750%10%20%10th90th$138$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $2,344.23 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $138.04 / $316.23
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $81.28 / $147.91
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,412.54 / $2,454.71 / $5,011.87
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $128.82 / $234.42
Baylor Scott & White
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $123.03 / $5,011.87
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $181.97 / $251.19
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $162.18 / $251.19
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $4,073.80
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,715.35
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $208.93 / $4,365.16
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $151.36 / $302.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $128.82
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $134.90 / $213.80
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $165.96 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $1,995.26 / $4,073.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $134.90 / $218.78
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $162.18